HLS 13RS-680 ORIGINAL
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Regular Session, 2013
HOUSE CONCURRENT RESOLUTI ON NO. 4
BY REPRESENTATIVE NORTON
MEDICAID: Directs the secretary of DHH to expand eligibility standards for the La.
Medicaid program to conform to those established in the Affordable Care Act
A CONCURRENT RESOLUTI ON1
To authorize and direct the secretary of the Department of Health and Hospitals to take such2
actions as are necessary to expand the eligibility standards of the Medicaid program3
of this state to conform such standards to those established in the Affordable Care4
Act.5
WHEREAS, the legislation referred to collectively as the "Affordable Care Act" or6
"ACA" consists of the following Acts of Congress:7
(1) The Patient Protection and Affordable Care Act (PPACA), which originated as8
H.R. 3590 in the One Hundred Eleventh United States Congress and became Public Law No.9
111-148.10
(2) The Health Care and Education Reconciliation Act (HCERA), which originated11
as H.R. 4872 in the One Hundred Eleventh United States Congress and became Public Law12
No. 111-152; and13
WHEREAS, the ACA sets forth monumental health policy reforms, as it reshapes14
the way virtually all Americans will receive and finance their health care; and15
WHEREAS, among the key features of the ACA are rights and protections for health16
care consumers, accountability measures for insurance companies, expanded eligibility for17
the Medicaid program, and a requirement that every American maintain a minimum level18
of health insurance coverage; and19 HLS 13RS-680 ORIGINAL
HCR NO. 4
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WHEREAS, in a decision announced on June 28, 2012, the United States Supreme1
Court in National Federation of Independent Business Et Al. v. Sebelius, Secretary of Health2
and Human Services, Et Al. upheld the overall constitutionality of the ACA; and3
WHEREAS, in the same ruling, a majority of the court held that the penalty for a4
state's nonparticipation in the expansion of Medicaid eligibility as provided in the ACA is5
unconstitutionally coercive because it entails withholding of all federal funds for existing6
Medicaid programs if a state does not expand Medicaid eligibility; and7
WHEREAS, the effect of this aspect of the court's decision is to make participation8
in the Medicaid expansion optional for the states; and9
WHEREAS, at twenty-five percent of the federal poverty level, or just under five10
thousand eight hundred dollars in annual income for a family of four presently, the income11
eligibility threshold of this state for Medicaid benefits for parents of Medicaid-eligible12
children is the second-lowest in the nation; and13
WHEREAS, the working poor of this state would benefit greatly from the expansion14
of Medicaid income eligibility, as provided in the ACA, to one hundred thirty-three percent15
of the federal poverty level, or thirty thousand seven hundred thirty-three dollars in annual16
income for a family of four presently; and17
WHEREAS, correspondingly, the working poor will be penalized to the greatest18
extent financially by the provisions of the ACA if this state refuses to participate in the19
Medicaid expansion and those families fail to maintain health coverage after January 1, 201420
as required by law; and21
WHEREAS, the ACA provides that Medicaid benefits for households who become22
eligible due to the expansion will be financed entirely with federal funds for the first three23
years of the expansion, and that the federal share of funding for benefits to these "new24
eligibles" will phase down from one hundred percent to ninety percent between 2017 and25
2020, with the federal share remaining at ninety percent in ensuing years; and26
WHEREAS, the Legislature of Louisiana does hereby affirm that the working poor27
of this state deserve access to health care, and that health care providers who serve the28
working poor must be assured of some amount of compensation for the care they deliver to29
this population; and30 HLS 13RS-680 ORIGINAL
HCR NO. 4
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WHEREAS, health care for Louisiana workers who do not qualify for Medicaid,1
whose jobs do not provide health benefits, and who cannot afford private health insurance2
has traditionally been financed by the Medicaid and Medicare Disproportionate Share3
Hospital (DSH) programs, which currently provide major support to hospitals that furnish4
uncompensated care to low-income uninsured persons; and5
WHEREAS, the ACA stipulates that beginning in 2014, the federal government will6
dramatically reduce DSH funding as presently-uninsured Americans obtain either private7
health insurance or Medicaid coverage as provided in the ACA; and8
WHEREAS, a state refusing to participate in the Medicaid expansion in the face of9
dramatically reduced DSH funding would create a truly untenable situation for working poor10
families and for all hospitals of the state, as the federal Emergency Medical Treatment and11
Active Labor Act (EMTALA) requires hospitals to provide care to anyone needing12
emergency treatment regardless of their ability to pay, and such law includes no provisions13
for reimbursing hospitals for such care; and14
WHEREAS, compared with the economic and human costs of a crisis in health care15
financing arising from non-participation in the Medicaid expansion coupled with an16
impending loss of DSH funding, the costs to Louisiana of avoiding this crisis by17
participating in the Medicaid expansion are negligible; and18
WHEREAS, it is absolutely clear that for compelling economic and moral reasons,19
participation in the Medicaid expansion is in the best interest of this state.20
THEREFORE, BE IT RESOLVED that the Legislature of Louisiana does hereby21
authorize and direct the secretary of the Department of Health and Hospitals to take all such22
actions as are necessary, including but not limited to amending the Medicaid state plan, to23
expand the eligibility standards of the Medicaid program of this state to conform such24
standards to those established in the Affordable Care Act.25
BE IT FURTHER RESOLVED that the secretary of the Department of Health and26
Hospitals shall submit to the Centers for Medicare and Medicaid Services the Medicaid state27
plan amendment necessary to institute the expanded eligibility standards as provided in this28
Resolution on or before September 1, 2013.29 HLS 13RS-680 ORIGINAL
HCR NO. 4
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BE IT FURTHER RESOLVED that a suitable copy of this Resolution be transmitted1
to the secretary of the Department of Health and Hospitals.2
DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part
of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute
part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
Norton HCR No. 4
Authorizes and directs the DHH secretary to take such actions as are necessary to expand
the eligibility standards of the Medicaid program of this state to conform such standards to
those established in the Affordable Care Act ("federal health reform"); and to submit by
Sept. 1, 2013 the Medicaid state plan amendment necessary to provide for the expansion.